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Radiographic Loss of Contact Between Radial Head Fracture Fragments Is Moderately Reliable

  • Symposium: Traumatic Elbow Instability and its Sequelae
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation).

Questions/purposes

(1) What is the interobserver agreement on radiographic loss of contact between radial head fracture fragments? (2) Are there factors associated with the observer such as location of practice or subspecialization that increase interobserver reliability?

Methods

Fully trained practicing orthopaedic and trauma surgeons from around the world evaluated 27 anteroposterior and lateral radiographs of radial head fractures on a web-based platform for the following characteristics: (1) loss of contact between at least one radial head fracture fragment and the remaining radial head and neck; (2) a gap between fragments of 2 mm or greater; (3) anticipated fracture instability (mobility) on operative exposure; (4) anticipated associated ligament injuries; and (5) recommendation for treatment. Agreement among observers was measured using the multirater kappa measure. Kappas for various observer characteristics were compared using 95% confidence intervals.

Results

The overall interobserver agreement was moderate (range, 0.49–0.55) for each question except associated ligament injury, which was fair (0.33). Shoulder and elbow surgeons had substantial agreement (range, 0.51–0.61) in many areas, but kappas were generally in the moderate range (0.41–0.59) based on number of years in practice, radial head fractures treated per year, and trainee supervision.

Conclusions

Radiographic signs of radial head fracture instability such as loss of contact have moderate reliability. This characteristic seems clinically useful, because loss of contact between at least one radial head fracture fragment and the remaining radial head and neck is strongly associated with associated ligament injury or other fractures.

Level of Evidence

Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands

    Wendy E. Bruinsma MD

  2. Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Thierry Guitton MD, PhD

  3. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA

    David Ring MD, PhD

Authors
  1. Wendy E. Bruinsma MD
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  2. Thierry Guitton MD, PhD
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  3. David Ring MD, PhD
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Consortia

Science of Variation Group

Corresponding author

Correspondence to Wendy E. Bruinsma MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.

Science of Variation Group:

Kevin Eng, Vispi Jokhi, David O. Oloruntoba, Sanjev Jain, Parag Melvanki, Frede Frihagen, Iain McGraw, Philipp Lenzlinger, K. J. Ponsen, Andrew Schmidt, Bernhard Ciritsis, Joseph M. Conflitti, Matthias Turina, Rudolf W. Poolman, Ronald Liem, R. S. Gulve, James Wagg, Peter Kloen, Elena Grosso, Matt Mormino, Pradeep Choudhari, Robert D. Zura, Rodrigo Pesantez, George Thomas, Peter Brink, Marc Swiontkowski, Daphne Beingessner, Niels Schep, Nikolaos Kanakaris, R. W. Peters, J. Andrew, I. Trenholm, Ladislav Mica, M. H. J. Verhofstad, Lisa Taitsman, Daniel Hernandez, Ian Harris, Kenneth Egol, Kyle Jeray, Lars C. Borris, Antonio Barquet, James Kellam, John L. Marsh, Jonathan L. Hobby, Parag Sancheti, Lob Guenter, Thomas DeCoster, Brett D. Crist, Gregory J. Della Rocca, Milind Merchant, Michael P. Leslie, Richard Jenkinson, David Weiss, Edward K. Rodriguez, Rena Stewart, John Wixted, Peter Althausen, Peter Schandelmaier, Brad Petrisor, Platz Andreas, Henry Broekhuyse, Clifford Jones, Edward Harvey, Fryda Medina Rodríguez, Hans J. Kreder, Michael Prayson, Raymond Malcolm Smith, Toni M. McLaurin, Arie B. van Vugt, Richard Buckley, Vishwanath M. Iyer, Fred Baumgaertel, Ross Leighton, Reto H. Babst, Qiugen Wang, Edward Yang, Eric Mark Hammerberg, Leon Elmans, Alan Kawaguchi, David B. Carmack, Amal Basak, George Kontakis, Jeremy Hall, Richard S. Page, Taco Gosens, Denise Eygendaal, Martin Richardson, Thomas Wright, George S. M. Dyer, Charalampos Zalavras, Frank Walter, Scott Duncan, Grant Garrigues, Steven Rhemrev, Abhijeet L. Wahegaonkar, Jonathan Rosenfeld, Sander Spruijt, Martin Boyer, Peter Jebson, Ramon de Bedout, John T. Bolger, Thomas J. Fischer, Waldo E. Floyd III, Julie Adams, Francisco Javier Aguilar Sierra, M. Jason Palmer, Sidney Jacoby, Todd Siff, Carrie Swigart, Gregory DeSilva, John Taras, Jeffrey Wint, Jim Calandruccio, Russell Shatford, Douglas T. Hutchinson, Takashi Sasaki, Richard Uhl, Jose Nolla, Sanjeev Kakar, Ekkehard Bonatz, Rick Papandrea, Michael Nancollas, Gustavo Mantovani Ruggiero, Richard Barth, Brent Bamberger, John McAuliffe, Marc J. Richard, Michael Baskies, Scott Mitchell, Daniel Polatsch, Jorge Boretto, Lisa Lattanza, Rozental, Charles Cassidy, David M. Kalainov, Eric Hofmeister, Lawrence Weiss, Leon Benson, Taizoon Baxamusa, Doug Hanel, Fabio Suarez, Alberto Pérez Castillo, David R. Miller, Chris Wilson, Timothy G. Havenhill, Michael W. Grafe, Saul Kaplan, Catherine Spath, Christopher J. Walsh, Kendrick Lee, John Howlett, Loren Potter, Patrick T. McCulloch, Boyd Lumsden, Nick Meyer, Ben Sutker, Charles Metzger, Jose A. Ortiz Jr, Steve Helgemo, Jason Fanuele, Jay Pomerance, W. Arnnold Batson, Shep Hurwit, J. C. Goslings, John G. DeVine, Scott Edwards, Thomas Hughes, Mahmoud I. Abdel-Ghany, I. J. V. Kleinlugtenbelt.

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Bruinsma, W.E., Guitton, T., Ring, D. et al. Radiographic Loss of Contact Between Radial Head Fracture Fragments Is Moderately Reliable. Clin Orthop Relat Res 472, 2113–2119 (2014). https://doi.org/10.1007/s11999-014-3592-z

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  • DOI: https://doi.org/10.1007/s11999-014-3592-z

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